Compact actuation configuration and expandable instrument receiver for robotically controlled surgical instruments

ABSTRACT

A robotic system assembly comprises a robotic manipulator including an actuator assembly and a surgical instrument having a base body mountable to the actuator assembly. The base includes a first control input and a second control input, wherein the first and second control inputs are positioned on different sides of the base. The actuator assembly is moveable between open and closed positions to facilitate removal and replacement of surgical instruments. When in the closed positions, drive elements of the actuator assembly are positioned to drive the first and second control inputs of the surgical instrument to cause end effector movement or actuation.

This application is a continuation in part of U.S. application Ser. No.16/732,307, filed Dec. 31, 2019, which claims the benefit of thefollowing U.S. Provisional applications: U.S. 62/874,988, filed Jul. 17,2019 and U.S. 62/787,254, filed Dec. 31, 2018. This application furtherclaims the benefit of U.S. Provisional Application Nos.: U.S.62/874,988, filed Jul. 17, 2019, U.S. 62/875,003, filed Jul. 17, 2019,U.S. 62/874,985, filed Jul. 17, 2019, and U.S. 62/874,982, filed Jul.17, 2019.

TECHNICAL FIELD OF THE INVENTION

The present invention relates to the field of surgical devices andsystems, including those using electromechanical actuation.

BACKGROUND

There are various types of surgical robotic systems on the market orunder development. Some surgical robotic systems use a plurality ofrobotic arms. Each arm carries a surgical instrument, or the camera usedto capture images from within the body for display on a monitor. Typicalconfigurations allow two or three instruments and the camera to besupported and manipulated by the system. Input to the system isgenerated based on input from a surgeon positioned at a master console,typically using input devices such as input handles. Motion andactuation of the surgical instruments and the camera is controlled basedon the user input. The image captured by the camera is shown on adisplay at the surgeon console. The console may be located patient-side,within the sterile field, or outside of the sterile field.

The robotic arms/manipulators include a portion, typically at theterminal end of the arm, that is designed to support and operate asurgical device assembly. The surgical device assembly includes asurgical instrument having a shaft and a distal end effector on theshaft. The end effector is positionable within a patient.

Typically, a proximal housing on the instrument shaft includes actuationmechanisms that receive motion transferred from actuators that drivefunctions of the instrument. The end effector may be one of manydifferent types of that are used in surgery including, withoutlimitation, end effectors having one or more of the following features:jaws that open and close, section at the distal end of the shaft thatbends or articulates in one or more degrees of freedom, a tip that rollsaxially relative to the shaft, a shaft that rolls axially relative tothe manipulator arm. The instrument actuators for driving the motion ofthe end effector, which might be motors or other types of motors (e.g.hydraulic/pneumatic), are often positioned in the terminal portion ofthe robotic manipulator. In some cases, they are positioned in theproximal housing of the surgical device assembly, and for otherconfigurations some are in the proximal housing while others are in therobotic manipulator. In the latter example, some motion of the endeffector might be driven using one or more motors in the terminalportion of the manipulator while other motion might be driven usingmotors in the proximal housing.

The instruments are exchangeable during the course of the procedure,allowing one instrument to be removed from a manipulator and replacedwith another. Engaging the proximal housing with the actuator interfaceat the manipulator may involve the use of mechanical snaps, magneticengagement, or sliding interfaces that rigidly dock the instrument tothe manipulator in order to resist external forces from both the robotand the patient. There is a mechanical interface to engage with surgicalinstruments. At this interface, motion generated using the instrumentactuators within the robotic manipulator is communicated to one or moremechanical inputs of the proximal housing to control the degrees offreedom of the instrument and, if applicable, its jaw open-closefunction. This motion may be communicated through a drape positionedbetween the sterile instrument and the non-sterile manipulator arm. Insome current robotic systems, the mechanical control interface includesactuators disposed only on one side or plane of an instrument. Forexample, in the configuration shown in U.S. Pat. No. 6,491,701, all ofthe driven elements 118 that receive mechanical motion are on the sameface of the housing 108 at the proximal end of the instrument shaft 102.

In the embodiment shown in U.S. Pat. No. 9,358,682, a transverse sliderpin 314 extends laterally from one side of the case mounted to theproximal end of the instrument. It is moveable to open and close jaws ofthe instrument (FIG. 18 of the patent). When the instrument is mountedto the manipulator arm, the slider pin 314 is received by acorresponding component 430 (FIG. 19 ) in the manipulator arm. When itis necessary to open/close the jaws, the component 430 is translated ona carriage by motors in the laparoscopic instrument actuator 400 of themanipulator arm, thereby advancing the slider pin 314 to actuate thejaws. US Application 2016/20160058513 also shows a roboticallycontrolled surgical instrument that is removably attached to amanipulator arm and describes a similar configuration in which a sliderpin is used for jaw actuation. It further describes a system that canprovide not only jaw actuation but additional electromechanically-drivenmovements of the instrument end effector, such as articulation orrotation. However, the motors for those additional movements areenclosed in the housing at the proximal end of the instrument and thusdo not require transfer of mechanical motion from motors in the arm tomechanical actuators of the housing.

This application describes a robotically controlled surgical instrumenthaving a plurality of mechanical actuators at its proximal end. Thesemechanical actuators are arranged to receive motion transferred fromelectromechanical actuators within the manipulator arm in order to drivevarious end effector functions or motion, such as jaw actuation, pitch,roll, and/or yaw. The actuators are arranged in a configuration that iscompact and that allows the manipulator arm to engage with instrumentsor adapters of varying sizes. The described embodiments also enableconfiguration of instruments or adapters such that the actuatinginterfaces may exist on more than one surface of the instrument oradapter, including surfaces that face away from one another.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a robot-assisted surgical system onwhich the configurations described herein may included;

FIG. 2 is a perspective view of a robotic manipulator arm with thereceiver and instrument assembly mounted to it;

FIG. 3 are a perspective view showing the receiver of FIG. 2 and thesurgical instrument separated from the receiver;

FIG. 4 shows the surgical instrument with the base removed;

FIG. 5 shows the proximal part of the surgical instrument;

FIG. 6 is similar to FIG. 5 , but shows a portion of the housingremoved;

FIG. 7 is similar to FIG. 6 , but shows a portion of the upper carriageremoved;

FIG. 8 shows the receiver of FIG. 2 ;

FIG. 9 is similar to FIG. 8 but shows a portion of the arm removed;

FIG. 10 is a side elevation view of the carriage and motor assemblies ofone arm of the receiver;

FIG. 11 is an alternate embodiment of a carriage for the instrumentbase;

FIGS. 12 and 13 are perspective views of alternate embodiments ofcarriages for one of the arms of the receiver;

FIGS. 14 and 15 are top plan views of the receiver, showing it in theopen and closed positions, respectively;

FIG. 16 is a perspective view showing the instrument mounted to thereceiver;

FIG. 17 is a perspective view showing the lever and linkages of thereceiver;

FIG. 18 is similar to FIG. 15 , but shows a portion of the receiverhousing removed to allow the expansion mechanism to be seen;

FIG. 19 is a side elevation view of the instrument and lever of FIG. 17and the associated motor;

FIG. 20A is a perspective view showing the receiver as it is beingdraped;

FIG. 20B is similar to FIG. 16 but shows the drape in place;

FIG. 21 is a perspective view of the drape connector;

FIG. 22 is a rear plan view of the base of the instrument;

FIG. 23 is a perspective view of an alternative embodiment of the base;

FIG. 24 is similar to FIG. 23 , but shows a portion of the housingremoved;

FIG. 25 is a perspective view showing one of pulley mechanisms andsprings of the embodiment of FIG. 23 .

FIG. 26A shows an example of a drape having integral EMI shielding;

FIG. 26B is a cross-section of a portion of the drape shown in FIG. 26A;

FIG. 26C is similar to FIG. 26B, but shows an embodiment includingelectrical connectors and terminations incorporated into the drape

FIG. 27 is similar to FIG. 16 and further shows a graphical userinterface disposed on the manipulator end effector.

FIG. 28 is similar to FIG. 27 , but illustrates features for providedforce feedback to a user during manual repositioning of the manipulator.

DETAILED DESCRIPTION

Although the concepts described herein may be used on a variety ofrobotic surgical systems, the embodiments will be described withreference to a system of the type shown in FIG. 1 . In the illustratedsystem, a surgeon console 12 has two input devices such as handles 17,18. The input devices 12 are configured to be manipulated by a user togenerate signals that are used to command motion of a roboticallycontrolled device in multiple degrees of freedom. In use, the userselectively assigns the two handles 17, 18 to two of the roboticmanipulators 13, 14, 15, allowing surgeon control of two of the surgicalinstruments 10 a, 10 b, and 10 c disposed at the working site (in apatient on patient bed 2) at any given time. To control a third one ofthe instruments disposed at the working site, one of the two handles 17,18 may be operatively disengaged from one of the initial two instrumentsand then operatively paired with the third instrument, or another formof input may control the third instrument as described in the nextparagraph. A fourth robotic manipulator, not shown in FIG. 1 , may beoptionally provided to support and maneuver an additional instrument.

One of the instruments 10 a, 10 b, 10 c is a camera that captures imagesof the operative field in the body cavity. The camera may be moved byits corresponding robotic manipulator using input from a variety oftypes of input devices, including, without limitation, one of thehandles 17, 18, additional controls on the console, a foot pedal, an eyetracker 21, voice controller, etc. The console may also include adisplay or monitor 23 configured to display the images captured by thecamera, and for optionally displaying system information, patientinformation, etc.

A control unit 30 is operationally connected to the robotic arms and tothe user interface. The control unit receives user input from the inputdevices corresponding to the desired movement of the surgicalinstruments, and the robotic arms are caused to manipulate the surgicalinstruments accordingly.

The input devices 17, 18 are configured to be manipulated by a user togenerate signals that are processed by the system to generateinstructions used to command motion of the manipulators in order to movethe instruments in multiple degrees of freedom and to, as appropriate,control operation of electromechanical actuators/motors that drivemotion and/or actuation of the instrument end effectors.

Sensors may optionally be used to determine the forces that are beingapplied to the patient by the robotic surgical tools during use. Forexample, a force/torque sensor on the surgical robotic manipulator maybe used to determine the haptic information needed to provide forcefeedback to the surgeon at the console. U.S. Pat. No. 9,855,662,entitled Force Estimation for a Minimally Invasive Robotic SurgerySystem, describes a surgical robotic system in which sensors are used todetermine the forces that are being applied to the patient by therobotic surgical tools during use. It describes the use of a 6DOFforce/torque sensor attached to a surgical robotic manipulator as amethod for determining the haptic information needed to provide forcefeedback to the surgeon at the user interface. In the presentlydisclosed embodiments, a sensor of this type may be optionally bepositioned on or just proximal to the receiver 104. The surgical systemallows the operating room staff to remove and replace the surgicalinstruments 10 a, b, c carried by the robotic manipulator, based on thesurgical need. When an instrument exchange is necessary, surgicalpersonnel remove an instrument from a manipulator arm and replace itwith another.

In general, the assembly includes a surgical instrument having a baseconfigured such that its driven members (which receive mechanical driveinput to actuate functions of the instrument's end effector) aredisposed on more than one side, face, facet or plane of a base at theproximal end of the instrument. The base is one that in use is receivedby an arm within which is electromechanical or hydraulic actuators thatdrive mechanical outputs. To maintain sterility of the surgicalinstrument, the system is designed to facilitate use of a surgical drapepositioned between the base of the instrument and the correspondingmechanical drive outputs on the arm. Positioning the instrumentactuators on more than one side, facet, face or plane of the instrumentaids in spreading out the forces and deflections imparted by theseactuators on the drape, allowing transfer of multiple mechanical inputsto the instrument while preserving the drape.

Referring to FIGS. 2 and 3 , this application describes an assembly 100of a surgical instrument 102 and a receiver 104. The receiver 104 isconfigured to removably receive the instrument 102. The receiver may bemounted to a support or manipulator 15, which may be a roboticmanipulator that robotically manipulates the instrument 102 in one ormore degrees of freedom during a procedure, or a support that remainsstationary during the course of surgery embodiments of a surgicalinstrument for a robotic surgical system. When the surgical instrument102 and receiver 104 are assembled, the receiver transfers motiongenerated by electromechanical actuators (e.g. motors orhydraulic/pneumatic actuators) in the receiver 104 or the arm 15 tomechanical actuators of the instrument to cause motion of a part of theinstrument. Examples of types of motion include, without limitation,articulation in one or more degrees of freedom (pitch, yaw), bending inone or more degrees of freedom, end effector roll, jaw actuation, etc.As discussed above, the surgeon moves the input devices 17, 18 (FIG. 1 )to provide inputs into the system, and the system processes thatinformation to develop commands for the relevant electromechanicalactuators in order to move the instruments and, as appropriate, operatethe instrument end effectors.

The surgical instrument 102 includes an elongate shaft 106, which ispreferably rigid but which may be flexible or partially flexible inalternative systems. An end effector 108 is positioned at the distal endof the shaft 106, and a proximal body or base assembly 110 is at theproximal end. The base assembly 110 (which will also be referred to asthe “base”) may include an enclosed or partially enclosed structure suchas a housing or box, or it may be a frame or plate. The base 110includes mechanical input actuators 112 exposed to the exterior of thesurgical instrument 102. In FIG. 3 , two actuators 112 are exposed at afirst lateral face of the base 110. A second two actuators 112 areexposed at the second, opposite, lateral face of the base 110,preferably but optionally in a configuration identical or similar to theconfiguration shown in FIG. 3 . See the rear view of the base 110 shownin FIG. 22 .

Each of the actuators 112 is moveable relative to the base 110 betweenfirst and second positions. In the specific configuration shown in thedrawings, the actuators are longitudinally moveable relative to thehousing between a first (more distal) position and a second (moreproximal) position such as that shown in FIG. 3 . The direction ofmotion, however, is not required to be longitudinal and can extend inany direction.

In this configuration, the base assembly thus has four drive inputs 122exposed to its exterior. In this configuration the base has two parallelplanar faces, with two of these inputs positioned on each of the faces.While it may be preferred to include the inputs on opposite sides of theproximal body, other arrangements of inputs on multiple faces of theproximal body can instead be used. Each of these configurationsadvantageously arranges the drive inputs in a way that maximizes thedistance between control inputs, minimizing stresses in the steriledrape that, as discussed below, is positioned between the proximal bodyand the receiver 104.

Referring to FIG. 4 , drive cables 114 extend through the shaft 106 tothe end effector 108. Many different types of instruments having any ofa variety of functions may be used in the disclosed system. Theinstrument depicted in the drawings is the type described incommonly-owned co-pending application Ser. No. 16/732,306, entitledArticulating Surgical Instrument, filed Dec. 31, 2019, which isincorporated herein by reference. It makes use of four drive cables 114two of which terminate at one of the jaw members and the other two ofwhich terminate at the other jaw member. This can be two cables loopedat the end effector (so each of the two free ends of each cable loop isat the proximal end) or it can be four individual cables. As describedin the co-pending application, the tension on the cables is varied indifferent combinations to effect pitch and yaw motion of the jaw membersand jaw open-close functions. Other instruments useful with the systemwill have other numbers of cables, with the specific number dictated bythe instrument functions, the degrees of freedom of the instrument andthe specific configuration of the actuation components of theinstrument. Note that in this description the terms “tendon,” “wire,”and “cable” are used broadly to encompass any type of tendon that can beused for the described purpose.

The four cables extend to the base 110 assembly. In this embodiment,where the base includes a housing, the cables extend from the shaft 106into the housing where they are engaged to the actuators 112. FIG. 6shows the base with a portion of the housing removed to allow a clearerview of the actuators 112. Each actuator 112 includes a carriage 118moveable along a rail 120. In this embodiment these structures areoriented for longitudinal movement of the carriage, but in others motioncan be in a different direction. A portion of the carriage 118 isexposed through a window in the base, and includes a drive input ormember 122 that extends laterally from the carriage and that mayoptionally extend through the outermost plane of the window (see FIG. 5). In FIG. 7 the carriage for the upper actuator is partiallydisassembled, showing that the proximal end of a cable 114 is mounted tothe carriage 118. The cable may extend around a pulley or through acable path defined by features of the base assembly. In thisconfiguration, a second cable end is similarly connected to the carriage118 of the lower actuator in FIG. 7 , and the remaining two cable endsare connected to the carriages at the opposite face (not shown) of thebase 100. In this way, the base assembly is arranged to have actuators112 exposed at at least two sides or faces of the base. Each actuator112 is connected to one of the cables 114 so that movement of theactuator in a first direction relative to the base increases tension onthe corresponding cable, and movement of the actuator in a second,different (or opposite) direction decreases tension on that cable. Inthe illustrated embodiment, movement of an actuators carriage 118 in aproximal direction increases or decreases (depending on the routing ofthe cable) tension on that cable, and movement of the carriage in adistal direction has the opposite effect on the cable tension.

In this embodiment, an extension spring 124 is connected between thecarriage 118 and a supporting structure of the base (in this case to theouter housing 126 or a partition 128 that divides the interior of thehousing into two laterally adjacent regions). Application of force tothe carriage to actively move the carriage in the direction against thespring force (in this case the distal direction) increases the tensionon the corresponding cable. When the applied force is released, thespring force moves the carriage back to or towards a home position andreduces the tension on the cable. In other embodiments, the carriage mayinstead be actively moved in both directions in lieu of the use ofspring force for one direction of motion.

Referring to FIG. 8 , the receiver 104 of the illustrated embodiment hasa generally U-shaped cross section, having two elongate sides and a seatspanning between the two sides. The sides of the “U” are formed by apair of distally-extending arm sections 130 a, 130 b, giving thereceiver an opening into which the base 110 is received when the systemis assembled (FIG. 3 ). Drive members 132, which will also be referredto as “drive outputs,” extend inwardly from the arm sections 130 a, b.They are positioned so that when the instrument is mounted to thereceiver 104, each drive input member 122 of the instrument (FIGS. 5 and6 ) is in contact with a corresponding one of the drive output members132. Two drive members 132 are visible in FIG. 8 . Two others extendfrom arm 130 b but are obscured in the drawing. In FIG. 9 , a portion ofthe arm 130 a is removed to show that the drive members 132 are carriedby carriages 134 housed within the arms 130 a, 130 b. Motors 136 withinthe receiver 104 (FIG. 10 ) drive linear movement of the carriages 134,and thus the drive members 132, along their respective arm sections 132a, b.

The type of contact between the drive members 132 of the receiver andtheir counterpart driven members 122 of the instrument is selected basedon the nature of the drive motion that is transferred to the drivemembers 122. In the linear drive configuration shown, the components maybe configured so that a carriage of the instrument can be pushed,pulled, or both pushed and pulled, by the corresponding drive componentof the receiver. Additionally, different carriages may be configureddifferently, with some only pushed and others only pulled (or some othercombination of push, pull, and bi-directional drive).

Where motion is driven in a single direction, contact between the drivemembers 132 and the driven members 122 is only needed in the directionof motion. In FIGS. 3-10 , the drive members 132 and the driven members122 are configured so that the drive members 132 push the driven membersin the distal direction, but need not pull the driven members in theproximal direction due to the presence of the springs 124 discussed inconnection with FIG. 7 . Thus, the face or region of each drive member132 facing the direction of motion (here the distal direction) contactsthe driven member 122. Thus, in this example, it is not necessary thatthe drive members and driven members be mated to one other or otherwiseengaged, although they could be. Instead, these members 122, 132 can besimply configured to have opposed surfaces (which may optionally beplanar) that contact one other. If motion was driven in the proximal butnot distal direction in this embodiment, the proximal face of the drivemember would contact the driven member.

In other embodiments motion of a driven member is driven in twodirections. In a linear drive arrangement such as is shown in thedrawings, this might mean that the drive member can both pull and pushthe driven member. In such embodiments, the drive member and drivenmember are configured to be engaged, mated, or otherwise designed to bein contact regardless of the direction of motion. For example, FIG. 11shows an alternative carriage 120 a for the instrument, which includes adriven member 122 a shaped to mate with the drive member 132 (FIG. 10 ).

FIG. 12 shows receiver carriages on which the drive members 132 a arecomprised of the walls of a female receptacle shaped to receive a drivenmember 122 of the type shown in FIG. 5 . FIG. 13 shows receivercarriages having two different drive member designs. On the uppercarriage the drive member 132 is similar to those previously discussed.On the lower carriage the drive member 132 a is comprised of the wallsof a female receptacle shaped to receive a driven member 122 of the typeshown in FIG. 5 . In this configuration, the upper carriage might drivethe corresponding driven member in a single direction (push or pull),while the lower carriage might drive the corresponding driven member inboth push and pull.

The receiver 104 may be one that expands to receive the base 110. Inthis embodiment, the receiver 104 is moveable from a closed position toan open position by increasing the separation between the arms 130 a,130 b. Once moved to an open position, any instrument held by thereceiver can be removed, and the base of a first or replacementinstrument may be received. The receiver is also moveable to reduce theseparation between the arms as it moves from the open position to aclosed position in which the base is captured 110 by the receiver 104.When in the closed system with a base 110 between the arms 130 a, b, thedrive inputs 122 of the base are operatively engaged (albeit notnecessarily physically engaged as discussed above) with the driveoutputs 132 of the receiver.

Expansion may be achieved in various ways. In the example shown in thedrawings the arms 130 a, 130 b pivot between the opened position (FIG.14 ) and the closed position (FIG. 15 ). In other configurations theymay move in parallel. When the receiver is closed to engage the base ofthe instrument, the arms of the receiver 104 reach around both sides ofthe base 110 to retain the base and to position the drive outputs wherethey will move the drive inputs to actuate degrees of freedom or otherfunctions of the instrument as described.

The receiver may be selectively opened and/or closed manually orelectromechanically my moving the arms towards/away from another. In thefirst embodiment, the arms 130 a, 130 b are pivoted relative to theirproximal ends by a rotatable lever or knob 138 having linkages 140spiraling outwardly from it. When the lever/knob is manually rotated ina first direction, the linkages 140 cam the arms 130 a, b to the openposition. Rotating the lever/knob in the opposite direction cams thearms to the closed position. In addition, or as an alternative, thelinkages 140 may be rotated by actuation of a motor 142. A switch 144 onthe receiver 104 may be used by a surgical assistant to activate themotor 142 to readily open and then close the receiver during aninstrument exchange.

The system may include features to facilitate alignment and retention ofthe instrument adapter while the actuator assembly of the manipulatorarm is open. Examples include tabs 146 on the base 110 or receiver 104that are received in corresponding seats 148 (FIG. 20 ) of the receiver104 or base 110. The proximal face of the base 110 may additionallyinclude alignment features. FIG. 22 shows female parts 150 (e.g.recesses, divots, holes or similar alignment features) that receive maleparts 150 (FIG. 21 ) as discussed in connection with the drape, below.As such, this embodiment has engaging and/or controlling features onthree sides of the base 110. It should be understood that control points(drive inputs) may exist on any side of the base and may be actuated byeither the electromechanical actuators of the receiver/manipulator, orby operating personnel at the bedside. Additionally, these controlpoints may share axes, have parallel axes, slide linearly along the sameplane, or may be a combination of movements that are not related (i.e.not planar, parallel or sharing the same axis).

Lastly, it is not required that the base have defined planes orinterface points. For example, an adapter body may be spherical orcylindrical in nature, where the control points are arranged across thesurface(s) of the body.

A second embodiment is similar to the first, having a “U” construction,but instead of angling the two sides of the “U” to reach the openposition, the sides expand while keeping the internal surfaces parallel.In this embodiment, a four-bar mechanism can be used, in concert with alever or knob system or motor to drive the opening and closing of thesystem.

Each of these concepts allows expansion of the space between the “U”sides, and this feature enables the acceptance of varying widths ofbases for instruments, cameras, or other adapters (e.g. a removableadapter on the proximal end of the camera or instrument, allowingcameras or instruments from various manufactures to be used with thesystem). For instruments having bases of different widths, the systemwould identify the instrument and close down the appropriate amount tohold the instrument base or adapter rigidly. For example, a non-contactreed switch board could be used to identify instruments or adapters ofvarying widths. One digital reading would result in a closure to a 30 mmspace between the arms 130 a, b, while another may result in 40 mm. Fora mechanical solution, a lever system could be used where theinstruments push with varying distances on the lever system. Forexample, a lever system may allow inputs from 0-4 mm, where 0 mm isfully open and 4 mm is fully closed. One instrument may push 4 mm toresult in a 30 mm space between the arms 130 a, b, or full closure,while another may push 3 mm to result in a 40 mm space.

It should be noted that the shape and size of the “U” and in the spacedefined by the arms 130 a, b can be adjusted to accommodate a widevariety of instruments or adapters. Additionally, while the “U” shapemay be preferable for this application, other shapes having at least twopartially opposing sides may be used, where the sides may not haveparallel, opposing faces.

A further advantage of the “U” shaped embodiments is the ability toengage some instruments such that the instrument shares the axis of thereceiver, but to engage others such that the instrument does not sharethe axis. For example, the receiver engaged with a camera system may beable to hold the camera so that the camera shaft and the receiver axesare at an angle, up to 90 degrees, relative to each other. This wouldallow the camera and light cords to pass “though” the receiver, ratherthan having to pass around it. Other instruments, such as harmonicenergy devices or staplers may benefit from this feature as well, whileallowing the mass of the instrument to be as close to the 6DOF forcesensor as possible.

Referring to FIGS. 20A and 20B, the receiver 104 is typically anon-sterile component that is covered by a sterile drape 154 or barrierbefore attachment of the sterile surgical instrument. At the interfacebetween the drive elements and the driven elements, the motion describedabove is communicated through the drape to control the degrees offreedom of the instrument. In one embodiment of a drape 154, the drapematerial is shaped to fit with the geometry of the receiver, having two“fingers” to cover the arms 130 a, b that open and close. It is optimalto ensure that the drape is properly oriented with the receiver and thatthe area for the instrument is clear for instruments to be engaged andremoved. In this embodiment, the drape includes an embedded plastic“drape connector” 156 adhered such that the connector has geometryextending to both sides of the drape. One side of the drape connectorincludes mating pins, posts, conical elements etc. that mate with femaleparts (e.g. recesses, conical divots, holes or similar alignmentfeatures) in the seat of the receiver 104, while the other mates withthe female parts 150 on the proximal face of the base. The mating pinsmay provide retention force to both the manipulator and instrument aswell as the orientation of the drape and instrument.

In this embodiment, the central male element 152 of the drape connectorhas two annular rings that allow mating geometry to snap into, providingthe retention force. In this case, the mating geometry may be a coiledspring. During the draping process, the drape is positioned over thearms 130 a, b of the receiver. The inward-facing face of the drapeconnector 156 is positioned so that the male members are inserted intothe female parts at the seat of the receiver, and the outward-facingface of the drape connector is similarly snapped into engagement withthe proximal face of the instrument base 110.

Because the drape connector extends through both sides of the drape, itmay be used as a sterile conduit for a variety of mechanical,electrical, optical or other tasks. A non-inclusive list of thesefeatures or tasks is included below.

-   The drape connector may be used to provide electrical signals    including power, ground, communication, etc. between the robotic    manipulator and the instrument    -   This electrical energy may be used to power instrument        recognition devices such as RFID transceivers, cameras,        proximity sensors or switches (including hall sensors and reed        switches). These devices may be able to determine what        instrument shaft is attached to a given base/adapter, while        allowing certain bases/adapters to be common for a variety of        instrument types.    -   This energy could also power sensors such as force and torque or        displacement devices as a means of measuring activity within the        instrument or the instrument adapter. These measurements may        enable better instrument control or user feedback such as force        feedback or tactile responses.    -   This electrical energy could be used for monopolar/bipolar or        advanced energy devices, eliminating the need for cables that        can get wrapped around the manipulator or instrument when the        manipulator is rotated.-   The drape connector may be used to provide optical signals or light    transmission between the robotic manipulator and instrument    -   These optical signals may be used for communication purposes        including instrument identification via spectroscopy or other        methods    -   These optical signals could be mated with a rod lens scope to        gain an intraoperative viewpoint without requiring a camera head        as with other endoscopes    -   The optical signals could be coupled with sensors such as fiber        optics for measuring deflection, for example. This deflection        could be used to interpret force on an instrument or adapter.

The drape connector may be used for other features as well. In thisembodiment, for example, the proximal surface of base has a flush portthat is intended to be used to clean the instrument adapter andinstrument shaft after a surgical procedure. If left open during theprocedure, this flush port is a leak pathway for CO2 to exhaust from theoperative site. The drape connector is used to plug this flush port,eliminating the leak pathway, while also eliminating components in theinstrument adapter such as check valves or elastomeric flush portcovers.

Second Embodiment

As discussed, in the first embodiment, the assembly is configured totransfer linear motion of a push/pull variety from the drive outputs tothe drive inputs, but other embodiments can be envisioned in whichrotary, or a combination of linear and rotary motion, can betransferred. See, for example the second embodiment of FIGS. 23-25 ,which show an alternate base 110 b. Here each of the drive elements 122b extends from a pulley 123 rotatably mounted to a structure (e.g.partition) within the base. Each cable is coupled to a corresponding oneof the pulleys 123. The linear motion of the drive outputs 132 (FIG. 8 )causes rotation of the corresponding pulleys 123 and thus alteration ofthe tension in the cables. This effects movement or actuation of the endeffector as described in connection with the first embodiment. Anexpansion spring 125 may serve to return the pulley to the unbiasedposition when the drive member removes or reduces the force against thedriven member, in a manner similar to that described with the firstembodiment.

Drape Incorporating EMI Shielding

The manipulator and related components may be covered by drapes using avariety of material types suitable for surgical draping. One example ofa drape that may be used will next be described in connection with FIGS.26A-26C. It should noted that this drape may be used to drape thedisclosed components, to drape components of alternative surgicalrobotics systems other than those described above, and to drape manyother components of sterile equipment (other than surgical roboticsystems).

If used with the embodiments described here, the drape might bepositioned as shown in FIGS. 20A and 20B, over the receiver 104 of thatembodiment before insertion of the proximal body 110 into the actuatorassembly.

The drape 200 is formed of a stretchable, multi-ply polymer containingintegral circuits printed with electrically conductive (or insulating)inks 204. The printed circuits may serve as a flexible Faraday cage toshield the contained device from electrostatic discharge and/orelectromagnetic interference. The ink may be printed in a mesh patternor other pattern suitable to create Faraday shielding. The printedcircuits may also serve as passive functional circuits such ascapacitive sensing (buttons), resistance sensing (strain measurement),antennas (RFID), etc. The printed traces may be sandwiched betweenlaminations 202 of drape material. Where electrical signals are to betransferred from one side of the drape to the other, the printed tracesmay be connected to conductive pads 205 for transferring electricalsignals into and out of the printed circuits. Likewise, the printedcircuits may connect to molded in components and features such asconnectors 210 and vias 208. The drape may take any form that is desiredand may be formed from a flat sheet (or roll) of material.

Drape 200 provides a low cost and efficient means of shielding aninstrument driver from ESD or EMI generated by high energy instrumentsthat may be mounted to it. In shielding applications, this methodreduces the complexity of designing electrical seals (such as springs)between moving interfaces in the device and eliminates the need to addelectrically conductive plating to external covers. It may also be usedto span gaps in the enclosed device which may otherwise be difficult toshield. It also can add functionality to the distal drape on a surgicalrobotic arm.

Graphical User Interface on Manipulator

A graphical user interface may be positioned on the manipulator. Thisfeature may be applied to any surgical robotic manipulator and while itis suitable for use with the configurations described above, it isequally suitable for use on components of other surgical roboticssystems.

In some robotic systems, for the convenience of surgical personnel, eachmanipulator may be individually identified using color coding, colorcoded tape, numbers, or other markings in one or more locations on eachmanipulator. Additionally, the cart supporting each manipulator mayinclude a screen for displaying error messages, and a series of lightsto indicate machine status.

At times during the course of a surgical procedure, it may becomenecessary for a surgical assistant or other operating room employee toreposition the manipulator. This may be done by applying a manual forceto the robotic arm and physically moving the robotic arm to the desiredorientation or position. This may be a purely manual activity as withthe prior art system, or it may be a power assisted activity. In eithercase, it would be advantages to notify the user about forces on theinstrument when the user is performing a manually driven motion.Typically, to move the manipulator when it is not being activelyteleoperated from the surgeon console, the user takes an action (e.g.simultaneously depresses two buttons on the manipulator) to unlock themanipulator so s/he can manually move the end effector of themanipulator to a desired position.

This section describes embodiments that consolidate functions ofinstrument status and error messages communication, manipulatoridentification and an easily accessible touch point for manipulation ofthe arm by a user, at a single site on the manipulator arm that iseasily accessible by the user regardless of the manipulator's endeffector orientation.

A first embodiment includes a surgical robotic system comprising atleast one manipulator arm. As shown in FIG. 27 , the manipulator arm(e.g. 13, 14, 15 of FIG. 1 ) has an end effector distal to at least onedegree of freedom of the manipulator arm. In this specific embodiment,the receiver 104 is part of the end effector. In use, as describedabove, a surgical instrument 106 is removably attachable to the endeffector.

On the end effector is a capacitive display screen 212 on which avariety of information can be displayed. In this embodiment, the displayscreen 212 is cylindrical, and extends around the body of the endeffector. The screen may be configured to change colors, display text oricons or other GUI items in order to communicate machine status, armidentification, instrument identification, etc to the user. Icons couldbe displayed and selected via touching the capacitive screen to performtasks such as calibration, homing or docking the end effector to thetrocar.

Additionally, touch gestures by the user on the capacitive screen couldelicit a response by the machine. For example, touching in two pointsspaced apart could unlock the degrees of freedom to allow manipulationor manual movement of the manipulator about its joints. Swiping couldchange between menus or tell the machine to go to a specific state(draping, etc). Gesture interaction with the display could also be usedto cause the system to place the manipulator in a state for, and/orcause activation of the manipulator's actuators to configure themanipulator in a position or orientation suitable for executingdifferent tasks (docking an instrument, exchanging instruments,calibration, homing, storage, draping, etc)

In a preferred configuration the touch screen wraps entirely around theend effector. In this configuration, the capacitive points can always beaccessed easily. Additionally, the inclusion of an inertial measurementunit (IMU) on or in the end effector provides feedback to the systemindicating the orientation of the end effector. Based on this feedback,the system would maintain or alter the position and orientation ofmessages and menus displayed on the GUI so that from the viewpoint of anoperator the messaging/menus are always in a specific orientation,regardless of the rotation of the end effector relative to the operator.In order words, the IMU would detect the orientation of the endeffector, and a processor of the system would select a region of thescreen that would be visible to a user in that orientation, and causethe relevant messaging and menus to be displayed in that region and,preferably, in an easily readable orientation for the user.

This feature enhances convenience of the surgical system use byincluding all of the available information about the system on displayat a location that is easily accessible at the patient-side. Touchpoints may be wrapped around the entire end effector, meaning they arealways accessible and in the same location (from the user'sperspective), regardless of the end effector's orientation. The displaymay include color changing displays that allow the use of color toindicate different operative states, or identification of different armsto the users.

Force Notification During Manually Driven Motion of a Manipulator

As discussed in the above section, at times during the course of asurgical procedure, it may become necessary for a surgical assistant orother operating room employee to reposition the manipulator. This may bedone by applying a manual force to the manipulator and physically movingthe manipulator to the desired orientation or position. This may be apurely manual activity as with some commercially available systems, orit may be a power assisted activity. In either case, it would beadvantageous to notify the user about forces on the instrument when theuser is performing a manually driven motion.

As also discussed in this application, a force/torque sensor, which maybe a 6DOF force/torque sensor, may be attached to the manipulator andused for determining the haptic information needed to provide forcefeedback to the surgeon at the user interface. FIG. 28 an end effectoras described above. Within the manipulator, in a region proximal to theinstrument position, is a 6DOF force/torque sensor 214 which, asdiscussed above, is used to measure forces experienced by the surgicalinstrument so that the system can communicate those forces to a user viaa haptic interface. Proximal to the sensor 214 is at least onenotification component 216, which may be at least one of a vibrationaltransducer, and a visual indicator or light emitter. Where a vibrationaltransducer is used, positioning it on the manipulator in a positionproximal to the sensor 214 helps avoid interference with forcemeasurements of the sensor 214. The visual indicator may be a light, LEDor collection of LEDs, image display, etc. If a GUI of the typedescribed in the previous section is used, it may be part of that GUI.These components are used to alert the user to the presence of forcesagainst the instrument while the system is being manually repositioned.

During a manual driven motion (motion performed by the user controllingthe movement of the arm with his/her hand on the arm), when a force isapplied on the instrument attached on the arm, a vibration and a visualalert from the light emitter are emitted. This alerts the person movingthe arm that the instrument is contacting tissue or another structure,so that additional precautions can be taken if warranted. This would beparticularly beneficial if, for example, an instrument is being insertedinto a trocar positioned at the incision site while the instrument isengaged to the arm.

The visual indicator may be configured to provide directionalinformation to the user to advise the surgeon. For example, it mayprovide a visual indication of the direction the arm should be moved inorder to alleviate the forces between the instrument and the tissue orother object. If the light emitter is a ring of lights or LEDsencircling a portion of the arm, a quadrant of those lights might beilluminated to mark the direction the user should push the arm in, orthe direction of the force against the instrument. If a flexible displayor GUI is used, one or more arrows or other symbols, icons, text etc.may be displayed for the same purpose. In some embodiments, the systemmay be configured to cause the amplitude/frequency of the vibration andthe intensity/blinking of the light to be proportional to the measuredforce on the force sensor 214.

During a remote driven motion (motion performed by the user controllingthe arm remotely using one of the user input devices 17, 18), when aforce is applied to the instrument attached on the arm (or if a forceexceeding a defined threshold is applied), a visual alert from the lightemitter may be emitted.

This feature may be used for any robotic manipulator and is not limitedto the embodiments described here. In general, it will be part of asurgical robotic system comprising a manipulator arm including a forceand torque sensor, a surgical instrument mountable to the manipulatorarm, a haptic user input device. The system includes at least oneprocessor, and at least one memory storing instructions executable bysaid at least one processor to do the following: in response to usermanipulation of the haptic user input device, cause the manipulator armto move the surgical instrument, in response to signals from the sensorduring user manipulation of the haptic user interface, causing actuatorsof the haptic user input device to apply force feedback to the hapticuser input device, and in response to signals from the sensor duringmanual user movement of the manipulator arm, activate a vibrationtransducer on the arm. The instructions may be further executable by theat least one processor to, in response to signals from the sensor,activate a visual alert on the arm.

Note that the vibrational transducer may be used to provide other typesof feedback to the user in addition to or as an alternative to forcefeedback. For example, if the system is configured to use theforce/torque to determine the fulcrum point for instruments passingthrough the incision as described in U.S. Pat. No. 9,855,662, thevibrational alert may be activated to notify the user that the fulcrumdetermination process is complete and the fulcrum has been set.

While certain embodiments have been described above, it should beunderstood that these embodiments are presented by way of example, andnot limitation. It will be apparent to persons skilled in the relevantart that various changes in form and detail may be made therein withoutdeparting from the spirit and scope of the invention. This is especiallytrue in light of technology and terms within the relevant art(s) thatmay be later developed. Moreover, features of the various disclosedembodiments may be combined in various ways to produce variousadditional embodiments.

Any and all patents, patent applications and printed publicationsreferred to above, including for purposes of priority, are incorporatedherein by reference.

We claim:
 1. A robotic manipulator having an actuator assembly at its distal end, the actuator assembly including: a first arm and a second arm having opposed first and second faces defining an instrument-receiving portion between the first arm and the second arm, at least one of the first arm and second arm moveable relative to the other of the first and second arms to move the actuator assembly between a first position in which the first and second arms are spaced by a first distance, and a second position in which the first and second members are spaced by a second, larger, distance; a first carriage carried by the first arm, the first carriage having a first drive element extending into the instrument-receiving portion; a first motor in the actuator assembly operable to move the first carriage relative to the first arm; a second carriage carried by the second arm, the second carriage having a second drive element extending into the instrument-receiving portion; a second motor in the actuator assembly operable to move the second carriage relative to the second arm.
 2. The manipulator of claim 1 wherein, the first carriage is positioned within the first arm, with the first drive element extending from within the first arm to the instrument-receiving portion, and wherein the second carriage is positioned within the second arm and with the second drive element extending from within the first arm to the instrument-receiving portion.
 3. The manipulator of claim 1, wherein the first and second faces are parallel to one another when the first arm and the second arm are in the first position.
 4. The manipulator of claim 1, further including a third motor operable to move said at least one of the first arm and the second arm to move the actuator assembly between the first position and the second position.
 5. The manipulator of claim 1 where the robotic manipulator includes a pass-through for instrument or camera cables.
 6. The manipulator of claim 5, wherein the pass-through extends through a portion of the actuator assembly.
 7. The manipulator of claim 1, wherein the first carriage includes a first drive element extending into the instrument-receiving portion and the second carriage includes a second drive element extending into the instrument-receiving portion, each of the first drive element and the second drive element translatable relative to the manipulator by its corresponding carriage.
 8. The robotic manipulator of claim 7, wherein at least one of the first drive element and the second drive element is translatable in a longitudinal direction relative to a longitudinal axis of the surgical instrument.
 9. The robotic manipulator of claim 8, wherein each of the first drive element and the second drive element is translatable in a longitudinal direction relative to a longitudinal axis of the surgical instrument.
 10. The robotic manipulator of claim 1, wherein in the second position the instrument-receiving portion is configured to be expanded to permit passage of a base of a surgical instrument between the first face and the second face, and wherein in the second position the instrument-receiving portion is configured to be partially closed to engage the base of the surgical instrument between the first arm and the second arm.
 11. The robotic manipulator of claim 1, wherein in the second position the instrument-receiving portion is configured to be expanded to permit passage of a base of a surgical instrument between the first face and the second face, and wherein in the second position the first carriage and the second carriage are positioned to permit operative engagement of the drive elements and corresponding drive inputs of the base during operation of the first motor and the second motor.
 12. The robotic manipulator of claim 1, wherein at least one of the first arm and the second arm is pivotable from the first position to the second position.
 13. The robotic manipulator of claim 1 wherein at least one of the first arm and the second arm is translatable from the first position to the second position.
 14. The robotic manipulator of claim 1 wherein at least one of the first arm and the second arm is slidably translatable from the first position to the second position.
 15. A robotic system assembly comprising: an actuator assembly, the actuator assembly including a first arm and a second arm having opposed first and second faces defining an instrument-receiving portion between the first arm and the second arm, the actuator assembly further including; a first drive element extending from the first arm into the instrument-receiving portion and a first motor operable to advance the first drive element relative to the actuator assembly; a second drive element extending from the second arm into the instrument-receiving portion and a second motor operable to advance the second drive element relative to the actuator assembly, wherein the first and second motors are independently operable to independently advance the first and second drive elements; a surgical instrument having a body removably positionable within the instrument-receiving portion of the actuator assembly, the body including a first control input and a second control input, each control input moveable relative to the body to actuate movement of at least a portion of the surgical instrument wherein the first and second control inputs are operatively associated with corresponding ones of the first and second drive elements when the bod is engaged in the instrument-receiving portion of the actuator assembly.
 16. The robotic system assembly of claim 15 wherein the first and second control inputs extend from the body in opposite directions.
 17. The robotic system assembly of claim 15 wherein the first and second control inputs extend from the body in non-parallel directions.
 18. The robotic system assembly of claim 15, wherein the first and second control inputs extend from the body in parallel directions.
 19. The robotic system assembly of claim 18, wherein a sterile barrier is disposed between the drive elements and the control inputs when the surgical instrument is mounted to the robotic manipulator.
 20. The robotic system assembly of claim 15, wherein the actuator assembly is moveable between an open position in which the actuator assembly is configured to receive the body to a closed position in which the first and second control inputs are operably associated with first and second drive elements of the actuator assembly. 